Multiple pregnancy Flashcards
define multiple pregnancy
when 2 or more eggs are released and fertilised (dizygotic twins)
or when a single fertilised egg divides early to form identical embryos (monozygotic twins)
what is the incidence of twins
twins- 1 in 90 pregnancies
triplets- 1 in 8100 pregnancies
when is having twins more common
african origin
recent OCP discontinuation
assisted conception
DZ twins more common in:
older mothers
increasing parity
maternal family history
what are dizygotic twins?
each twin is separate individuals with its own planet, amnion and chorion
from 2 separate fertilised eggs
essentially just siblings
fraternal twins
what are monozygotic twins?
identical
roughly 1/3 of twin pregnancies
about 1% are conjoined
connection between fetal circulations via the placenta
same genes, blood group, physical features,
may be separated by chorion
3 kinds of MZ twins dependant on when divide occurs
what are the 3 types of MZ twins?
DCDA
DCMA
MCMA
what are the risks with MCMA?
conjoined twins
cardiac twin/twin reversal arterial perfusion syndrome
TTTS- renal?
IUGR - usually one twin
cord entanglement
what are the maternal problems?
exacerbation of minor disorders
anaemia
PIH
APH
what are the fetal problems?
fetal malpresentation
locked twins can occur with a breech and vertex presentation
cord problems - prolapse, velametous insertion, entanglement
preterm labour
mode of delivery
what is the management for birth?
likely to labour early - 60% spontaneous before 37/40, the more foetuses the earlier labour will start
obstetric advice - IOL 38/40 DC, 36-37 MC
if 1st twin cephalic - vaginal birth encouraged
if the presentation for triplets - ELCS
duration of labour should be same as singleton, increased risk due to distended uterus
what is the management for labour?
CTG or 2 topples or poniards
mobilisation encourager
extra comfort support
may require epidural in case of manipulation of 2nd twin
if fetal distress EMCS
poor uterine action - oxytocics
babies may be preterm
outline the birth of twin 1
normal birth, note time, label, tag baby and cord
reassurance for patrons and good communication
baby to mum/dad in good condition
outline the birth of twin 2
ascertain lie of 2nd twin by USS
confirm by VE
ARM after PP engaged, obstetrician may stabilise 2nd twin
Increased risk of fetal compromise due to position or placental separation
wait up to 45 mins for 2nd twin so long as all is well
uterotonic after after 2nd twin
CCT to both cords simultaneously
examination of placenta and histology
what complications can occur?
common: polyhydramnios malpresentation PROM cord prolapse delay in 2nd twin PPH
rare: conjoined twin locked twins TRAP TTTS vanishing twin
